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Deep Tie

Page 2 of 2

5

Purple strand

 

Purple strand

6

 

looped over and

 

looped around

 

 

under white

 

white strand to

 

 

strand with right

 

form second loop.

 

 

hand.

 

This throw is

 

 

 

 

advanced into the

 

 

 

 

depths of the

 

 

 

 

cavity.

 

 

 

 

 

 

7Horizontal tension applied by pushing down on purple strand with right index finger while maintaining countertension on white strand with left index finger. Final tension should be as nearly horizontal as possible.

Ligation Around Hemostatic Clamp

Ligation Around Memostatic Clamp -More Common of Two Methods

Frequently it is necessary to ligate a blood vessel or tissue grasped in a hemostatic clamp to achieve hemostasis in the operative field.

1When sufficient tissue has been cleared away to permit easy passage of the suture ligature, the white strand held in the right hand is passed behind the clamp.

Left hand grasps free 2 end of the strand and gently advances it behind clamp until

both ends are of equal length.

3

To prepare for

 

As the first throw

4

 

placing the knot

 

of the knot is

 

 

 

completed the

 

 

 

 

 

square, the white

 

assistant removes

strand is

 

the clamp. This

transferred to the

 

maneuver permits

right hand and the

 

any tissue that

purple strand to

 

may have been

the left hand, thus

 

bunched in the

crossing the white

 

clamp to be

strand over the

 

securely crushed

purple.

 

by the first throw.

 

 

The second throw

 

 

of the square knot

 

 

is then completed

 

 

with either a two-

 

 

hand or one-hand

 

 

technique as

 

 

previously

 

 

illustrated.

Ligation Around Hemostatic Clamp -Alternate Technique

Some surgeons prefer this technique because the operator never loses contact with the suture ligature as in the preceding technique.

1Center of the strand placed in front of the tip of hemostatic clamp with purple strand held in right hand and white strand in left hand.

Purple strand swung

2

 

behind clamp and

 

grasped with index

 

finger of left hand.

 

Purple strand will be

 

transferred to left

 

hand and released by

 

right.

 

 

 

3

Purple strand

 

First throw is

4

 

crossed under

 

completed in

 

 

white strand with

 

usual manner.

 

 

left index finger

 

Tension is placed

 

 

and regrasped

 

on both strands

 

with right hand.

 

below the tip of

 

 

the clamp as the

 

 

first throw of the

 

 

knot is tied. The

 

 

assistant then

 

 

removes the

 

 

clamp. The square

 

 

knot is completed

 

 

with either a two-

 

 

hand or one-hand

 

 

technique as

 

 

previously

 

 

illustrated.

 

 

 
Источник: https://studfile.net/preview/16544898/

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